Public Health Report : Tai Chi for Balance
Author : Eric L. Zielinski
People often underestimate the importance of balance until they encounter an issue in maintaining it. It’s really something most people take for granted as their inner-balance mechanisms are constantly at work and are completely involuntary, much like breathing and blinking. Long praised for its positive benefits on balance, research journals are loaded with studies proving that Tai Chi is a mainstay for people to maintain proper balance.
According to the Mayo Clinic,
“Balance problems include a wide range of symptoms, from dizziness to light-headedness. Your muscles, bones and joints (musculoskeletal system), visual senses, hearing, central nervous system, and blood and heart vessels (cardiovascular system) must work normally for you to have normal balance. When these areas aren’t functioning well, you may experience balance problem symptoms. Most balance problems result from problems in your inner ear (vestibular system).”
Thus, in effect, as is shown below, since Tai Chi drastically improves one’s balance, it is ultimately improving everything above from the central nervous system to the cardiovascular system.
Medical Research and Management
The Mayo Clinic, for example, offers the latest diagnostic tests to help identify the cause of your balance problem. Mayo Clinic is one of few medical centers in the country to offer comprehensive testing in state-of-the-art vestibular and balance laboratories.
They also take a team approach to balance issues recruiting the following specialists:
- Ear, nose and throat (ENT doctors)
- Hearing (audiologists)
- Brain and nervous system (neurologists)
- Brain and nervous system surgery (neurosurgeons)
- Mental health (psychiatrists and psychologists)
- Physical medicine and rehabilitation (physiatrists)
- Physical therapists
Generally the Mayo Clinic team will recommend the following:
- Vestibular rehabilitation. Also known as balance retraining exercises, people with balance disorders will work with therapists to design a customized program of balance retraining and exercises. It is expected that the therapy will help patients compensate for imbalance, adapt to less balance and maintain physical activity.
- Fall prevention. In vestibular rehabilitation, therapists will work with patients to prevent falls. Some people may benefit from a balance aid, such as a walking stick or cane. Therapists also may discuss home safety and assistive devices to help reduce risk of falls.
- Positioning procedures. If the cause of balance problems is benign paroxysmal positional vertigo (BPPV), a therapist may conduct a positioning procedure, which involves maneuvering the position of the head. This procedure clears particles out of the inner ear canal and deposits them into a different area of your ear, which often reduces or resolves your symptoms. This is a non-invasive procedure in which the physician very specifically and gently moves the patient’s head with their hands while the patient is sitting, lying down on their back or on their side.
- Diet and lifestyle changes. Diet and lifestyle changes may also help people with balance problems. It is believed, for example, that people with Meniere’s diseases should decrease their salt intake to help reduce symptoms related to imbalance. Also, people with migraine-related dizziness may benefit by reducing caffeine, alcohol, nicotine and chocolate. For people with orthostatic hypotension – where the patient experiences a significant drop in blood pressure when standing from a seated position – Mayo Clinic physicians recommend an increase in fluid intake and to wear compressive stockings or undergo postural conditioning.
- Medications. For people with Meniere’s disease, migrainous vertigo or psychiatric disorders medications like meclizine (Antivert) or diazepam (Valium) are prescribed in an effort to reduce the spinning sensation of vertigo and help control nausea and vomiting. Anti-nausea medications, such as promethazine, are intended to control nausea and vomiting during an episode of vertigo.
- Surgery. Patients with Meniere’s disease or acoustic neuroma may also undergo surgery. The Mayo Clinic recommends stereotactic radiosurgery as an option for some people with acoustic neuroma. This procedure delivers radiation precisely to the tumor suspected to be the cause of balance-related issues and does not require an incision.
It is suspected that only 10 percent of patients are compliant to lifestyle changes recommended by their doctors. Consequently, most medical treatment protocols for issues like balance disorders center on drugs and surgery. The danger of this is paramount as it enables people to continue unhealthy and harmful habits and never allows them to take control of their lives and to see their problems dissolve.
Research showing Tai Chi’s ability to help improve balance
According to the Centers for Disease Control and Prevention (CDC), “Older adults who are at risk for falling should do exercises that help them with balance. Try to do balance training on at least 3 days a week and do standardized exercises from a program that’s been proven to reduce falls. These exercises might include backward walking, sideways walking, heel walking, toe walking, and practicing standing from a sitting position.” Specifically, they recommend Tai Chi.
• In a paper presented at the 2009 American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting & OTO EXPO in San Diego, researchers evaluated the ability of Tai Chi to manage patients with balance problems who have failed conventional vestibular therapy including such treatments as individualized physical therapy or positioning procedures. After questioning 21 participants who practiced Tai Chi in an outpatient rehabilitation center, the patients reported subjective improvements to their balance concerns. Science Daily reports that researchers theorize that the technique is effective because Tai Chi promotes coordination through relaxation, rather than muscular coordination.
• To look at center-of-pressure (COP) excursions beneath the feet, researchers from Beth Israel Deaconess Medical Center conducted a study in which 25 older adults with peripheral neuropathy participated in one-hour group sessions of Yang style Tai Chi three times a week for 24 weeks. Standing postural control was measured with force platform and COP dynamics, plantar sensation and physical function were assessed. Participants of the Tai Chi group exhibited increased complexity of standing COP dynamics, as defined by the presence of fluctuations existing over multiple timescales; improved plantar sensation and overall physical function. These factors contribute to better balance and postural control that ultimately leads to less falls.
• In 2013, a study was published in the Journal of Physiotherapy in which Tai Chi’s ability to increase postural control was tested for Parkinson’s patients between 40 – 85 years old. 195 participants were recruited and 65 were allocated to participate in a 24-week Tai Chi program, 60-minute sessions, twice a week. The study reported that maximal excursion, directional control, stride length and functional reach, increased considerably for the Tai Chi in comparison to the other two groups in which 65 underwent leg muscles strengthening exercises and 65 upper and lower body stretching regimens. In addition, the Tai Chi group reported significantly less falls and was proven by the research team to be “effective in reducing balance impairments in patients with mild to moderate Parkinson’s disease.”
• The pre-cursor to the above study was one that was published in the world-renown New England of Medicine in 2012. Randomly assigning 195 patients with stage one to four Parkinson’s disease to three similar groups — Tai Chi, resistance training, and stretching – the patients participated in 60-minute sessions twice a week for 24 weeks. Similar findings with the study above, the researchers reported that, “The Tai Chi group performed consistently better than the resistance-training and stretching groups in maximum excursion… The Tai Chi group also performed better than the stretching group in all secondary outcomes and outperformed the resistance-training group in stride length and functional reach. Tai Chi lowered the incidence of falls as compared with stretching but not as compared with resistance training.” Fascinatingly, the positive effects of Tai Chi training were “maintained at three months after the intervention” showing that its benefits are not short-lived. In addition to no serious adverse events being observed, the authors concluded, “Tai chi training appears to reduce balance impairments in patients with mild-to-moderate Parkinson’s disease, with additional benefits of improved functional capacity and reduced falls.”
• In 2003, the Journal of Rheumatology published a very ambitious study in which South Korean researchers from Soonchunhyang University tested the “effects of Tai Chi exercise on pain, balance, muscle strength and perceived difficulties in physical functioning in older women with osteoarthritis” on 72 women over a 12 week period. They found that the experimental group perceived significantly less pain and stiffness in their joints and reported fewer perceived difficulties in physical functioning, while the control group showed no change or even deterioration in physical functioning after 12 weeks. In the physical fitness test, there were significant improvements in balance and abdominal muscle strength for the Tai Chi exercise group. Interestingly, no significant differences were found in flexibility and upper-body or knee muscle strength. Nonetheless, the researchers concluded that, “Older women with OA were able to safely perform the 12 forms of Sun-style Tai Chi exercise for 12 weeks, and this was effective in improving their arthritic symptoms, balance, and physical functioning.”
• Likewise, to determine the effect on balance and strength, University of Connecticut School of Medicine recruited 110 participants to engage in 3 months of intensive balance and/or weight training followed by 6 months of low intensity Tai Chi training for maintenance of gains. Subjects were healthy and were an average age of 80 years. They were free of dementia, neurological disease, and serious cardiovascular or musculoskeletal conditions. Short-term training lasting 3 months occurred 3 times per week. Balance training included equilibrium control exercises on firm and foam surfaces and center-of-pressure biofeedback. Strength training consisted of common lower extremity weight lifting exercises. All subjects then received long-term group Tai Chi instruction for 6 months; one hour per session, one time per week. Balance training meaningfully improved all balance measures by restoring performance to a level analogous to an individual 3 to 10 years younger. Strengthening also increased torque of eight lower extremity movements. Of particular interest is that “gains persisted after 6 months of Tai Chi” suggesting that Tai Chi contributes not only to improved balance, but also strength.
• Not only a complication of falls, it has been shown that depression can cause falls which highlights their bidirectional relationship. Thus, excessive fear of falling – also associated with depression – greatly increases one’s likelihood to fall. According to University of Toronto researchers, “Both depression and fear of falling are associated with impairment of gait and balance, an association that is mediated through cognitive, sensory, and motor pathways.” To complicate matters, anti-depressant medications can increase the risk of falls thereby putting an elderly individual battling depression between a rock and a hard place. University of Toronto researchers highlight this challenging interplay in an article they published this past year in the American Journal of Geriatric Psychiatry and thus recommend that,” Based on the current state of knowledge, exercise (particularly Tai Chi) and cognitive-behavioral therapy should be considered for the first-line treatment of mild depression in older fallers.”
Summary and Conclusion
In light of the strong research supporting Tai Chi and balance control and the inherent dangers of drugs and surgery, it is recommended that people adopt easy and cost-effective stabilization techniques like Tai Chi as part of their daily lifestyle. As seen above, the effects of such a lifestyle change will permeate through the entire body and people will most certainly see other areas of their health improve as well.
Medical Studies and Resources
Beth Israel Deaconess Medical Center
American Academy of Otolaryngology
Journal of Rheumatology
Journal of Physiotherapy
American Journal of Geriatric Psychiatry
Journal of the American Geriatrics Society
New England Journal of Medicine
Public Health Report : Tai Chi for Balance
Author : Eric L. Zielinski